内镜下高频电凝切除术与EMR术治疗老年胃息肉的临床疗效及复发的相关因素分析

Clinical effects of endoscopic high-frequency electrocoagulation resection and EMR in the treatment of elderly patients with gastric polyps and factors related to recurrence

目的探讨内镜下高频电凝切除术与内镜下黏膜切除术(EMR)治疗老年胃息肉的临床疗效及复发的相关因素。方法收集2019年12月—2021年1月本院收治的80例(息肉共158枚)老年胃息肉患者的临床资料,按照手术方法不同将患者分为对照组(n=38,息肉78枚)和观察组(n=42,息肉80枚),对照组行内镜下高频电凝切除术,观察组行EMR术。比较两组患者围术期指标、临床疗效、氧化应激指标,统计并发症发生情况及术后复发率,并分析胃息肉术后复发的危险因素。结果观察组手术时间长于对照组,术中出血量少于对照组,术后住院时间短于对照组(均P<0.05);观察组临床有效率(90.48%)显著高于对照组(71.05%)(P<0.05);术前,两组患者血清羟色胺(5-HT)、谷胱甘肽过氧化酶(GSH-Px)水平比较无明显差异(P>0.05),术后,两组患者血清5-HT均升高,血清GSH-Px水平均降低,且观察组优于对照组(P<0.05);观察组并发症总发生率(2.38%)低于对照组(15.79%)(P<0.05);两组患者术后复发率比较。差异无统计学意义(P>0.05);经单因素及多因素Logistic回归分析结果显示,年龄、息肉直径为胃息肉复发的危险因素。结论内镜下EMR术治疗老年胃息肉疗效显著,相较于高频电凝切除术,可有效促进术后恢复,且氧化应激反应小,安全性较好,术后复发与手术方法无明显关联,主要影响因素为患者年龄及息肉直径。

Objective To analyze the clinical effects of endoscopic high-frequency electrocoagulation resection and endoscopic mucosal resection(EMR)in the treatment of elderly patients with gastric polyps,and factors related to recurrence.Methods The clinical data of 80 elderly patients with gastric polyps(158 polyps in total)admitted to our hospital from December 2019 to January 2021 were collected retrospectively.They were divided into control group(38 patients with 78 polyps treated with endoscopic high-frequency electrocoagulation resection)and observation group(42 patients with 80 polyps treated with EMR)according to the surgical method.Perioperative indicators,clinical effects,and oxidative stress indicators were compared between the groups.The incidence of complications and postoperative recurrence rate were calculated.The risk factors for postoperative recurrence of gastric polyps were analyzed.Results The operation time of observation group was longer than that of control group,the intraoperative blood loss was less than that of control group,and postoperative hospital stay was shorter than that of control group(P<0.05).The clinical effective rate in observation group(90.48%)was significantly higher than that in control group(71.05%)(P<0.05).There was no statistically significant difference in the levels of serum 5-hydroxytryptamine(5-HT)and glutathione peroxidase(GSH-Px)between the two groups before surgery(P>0.05).After surgery,serum 5-HT level was increased and serum GSH-Px level was reduced in the two groups.Meanwhile,the two in observation group were better than those in control group(P<0.05).The total incidence of complications in observation group(2.38%)was lower than that in control group(15.79%)(P<0.05).There was no statistically significant difference in postoperative recurrence rate between the two groups(P>0.05).Univariate analysis and multivariate Logistic regression analysis showed that age and polyp diameter were risk factors for recurrence of gastric polyp.Conclusion EMR is effective in the treatment of elderly gastric polyps.Compared with high-frequency electrocoagulation resection,it can effectively promote postoperative recovery,with less oxidative stress and better safety.There is no obvious relationship between postoperative recurrence and surgical method,and the main influencing factors are patient age and polyp diameter.